Supercharge Your Recovery With Electrical Stimulation

Terry Wahls, MD

Welcome, Garrett. I am so excited that you agreed to be part of the MS Neuroimmune Summit. Now I am thrilled to have you. But I would like to have you do is introduce yourself and explain why you have this magical expertise.

Garrett Salpeter 

Well, thank you so much, Dr. Wahls. It is great to be here and get to catch up with you and be involved in this amazing project. My background is really engineering and neuroscience. I feel very blessed to have found a way to overlap and intertwine these areas where I have a lot of formal training with my passion for the human body. And I started down this path initially as an athlete looking for ways to recover faster. And it is so interesting that so much of that work is really focused on the hardware of the body, the tendons, the ligaments, the muscles, the tissues, bones, etc. And the big breakthrough for me came when I recognized the neurological component even to more physical injury of learning that it was not as much about the injury itself or the original insult but the response to that injury, the response to that trauma and that is neurological in nature. And by working on that, started off working with more people like myself, athletes helping them recover faster but we saw the power of this neurological approach and very naturally over time we started applying it with people who have neurological injuries like spinal cord injuries and neurodegenerative diseases like MS and the various others that we are talking about on this series of talks here.

Terry Wahls, MD

Let us talk about one of my favorite topics, neuroplasticity. Many of us who have multiple sclerosis discover that you can stop the relapses with drugs very effectively now but there is still this slow deterioration that continues. And what role does neuroplasticity have in our ability to recover from that slow deterioration that really begins to occur often around the age of 40?

Garrett Salpeter 

First of all, I think it is important for us to understand what neuroplasticity is. And that is the capacity that we all have to adapt and change to what we experience in the world, to our environment, to the various inputs. An example of that is a child who grows up here in the United States might hear English or Spanish and naturally learn to understand that language and speak with that dialect and accent, whereas a child who grows up in China is going to learn Mandarin and understand those tones and inflections and that language, that is an example of adapting to the signals from the environment, the language that they are constantly hearing. We all adapt to that, certainly, more in childhood. But one of the biggest breakthroughs in neuroscience in the last few decades is understanding that we maintain some of that ability to adapt even in later years. Even for people in their 40s, 50s, 60s, and 70s, there are still opportunities to change. For a while, it was thought that whatever neurons we have, that is it, in the brain and in the body that things were hardwired and they could not change after a certain period of time. 

And we are learning more and more that it is not necessarily as much change as can happen in children but there is a capacity for people to change even in those even in those later years. And that opens up this possibility for MS patients, patients with other autoimmune conditions where they have these degenerative changes opens up an opportunity for them to harness the power of neuroplasticity to help restore that function that has been lost. And that, of course, comes with the caveat that you have to first do all of the other wonderful interventions that you teach about and the other speakers in this series are talking about, you have to first do what you can to stop the progression of the disease and quell that autoimmune situation and then from there you can talk about working to restore the function that is been lost and trying to get back to baseline. 

Neuroplasticity is the capacity to change. And it is neutral, we can change in a positive direction, and we can change in a negative direction. And part of that ongoing progressive deterioration that you are talking about is neuroplasticity but it is neuroplasticity in the negative direction. Because there are two main parts there that I think we really have to consider. There is, use it or lose it is a big one. Our brains are oriented toward survival and protection. Our brains want us to do less and not more because our brains want to conserve energy in case there is a famine. Our brains want to not have us create too much force or move too fast or stretch too far because we could get injured. And of course, the more primitive parts of our brain have, they are really focusing on survival, they want to limit us so that we do not get injured or we are not at risk of getting eaten. 

Terry Wahls, MD

Correct. For those who have MS and neuroimmune problems as we do less and less, we become more deconditioned and that accelerates our disability. And the reason I am so thrilled that you are here is because of your intellectual stimulation of muscles. And that was a big part of my recovery. I had worked with a physical therapist who treated athletes and used electrical stimulation in his athletic practice to help them recover from injuries more quickly. And I convinced him to try it on me. Zap me, man, it was uncomfortable and I let him really zap me but I felt great, my brain loved electricity. Let us talk about that and talk about the NEUBIE and why you think my brain so loved that electricity.

Garrett Salpeter 

Yeah. This is where we can now start to tap into the positive side of neuroplasticity instead of things adapting and getting worse. This is where we can cause the function to improve over time whereas neuroplasticity is just for that to kind of set the foundation here if we are talking about neuroplasticity helping people in a positive direction we have to look at the fundamental level, look at the mechanism. If the immune system, if there is an autoimmune condition has caused degeneration within nervous system tissue whether it be myelin, of course, in the case of the MS or other parts of nerves or connections between them we have to either stimulate the body to repair the tissue that has been damaged or cause a functional reorganization where the body may use a detour or a new pathway to accomplish the same goal. 

Typically, if there is damage in the brain it is easier to find detours. If we are talking about nerves in the body it is typically more about rebuilding and repairing the damage that the body has experienced. That is what we need to do if we are wanting to restore function. And in order to do that there has to be enough input so that the brain understands, the brain gets the point, hey, we actually are going to use these pathways, hey, it actually is worth investing the energy and resources to repair these and maintain them for the long term. Because if you just do something once your brain says, it is not worth it, it is not worth investing all those resources to up-regulating, rebuilding, repairing, and maintaining that neurological pathway. You need enough triggers here to do that. 

There is this underlying theme that we are going to have to if we are talking about MS, or patients, or patients in similar circumstances, we are going to have to start thinking of ourselves as athletes because it takes a lot of work to flip the switch to where the brain essentially starts to shift into the state where it is going to invest these energy resources for long term building repair. Basically, you have to work hard, you have to treat yourself like an athlete. And to your point about your brain starting to feel good, when you are getting enough of the right kinds of input, then we are starting to get these short-term benefits of exercise on the brain, whether it be the releasing of endorphins or BDNF, a brain-derived neurotrophic factor which can help stimulate growth and stuff in there. 

We are getting neurotransmitters. I mean, we are getting some epinephrine and dopamine and we are getting these wonderful things that help the brain function better in the short term. And then doing that once is not enough we have to then maintain that for the long term as well. And where electrical stimulation comes in is that there is this amount of input that we need both within each session and then cumulatively over time. And that amount of work, it is like if you were driving from New York City to LA. If you were traveling from New York City to LA, if you have this fixed distance that you have to go you could walk it, you could ride horseback, you could drive it, or you could fly, there are different ways to get there, but some are more time efficient and quicker than others and perhaps safer and then others take longer and less efficient. And using technology like the NEUBIE for different reasons that we can talk about is going to be among the most efficient, if not the most efficient way to achieve that input. You are going to be experiencing a lot of input within one session which is part of why the brain, we know about these beneficial effects of exercise on the brain, you are going to be experiencing that increased cognitive function from all these boosts from of all these wonderful chemicals in short term and you are also going to be getting that because you are going to get the input. 

If you need to do thousands of reps of a movement within each session or each week in order to accumulate hundreds of thousands to drive these changes over time with the input of something like the NEUBIE device you can get so much input to where each movement, when you do a movement of your arm, for example, say you send one signal like, okay, this happens, the load on the tissues is one signal to the brain, maybe with the NEUBIE on each movement is actually the equivalent of five signals to the brain because you are getting this barrage of input and it starts to create that input that accelerates this process, it gets you from New York to LA faster. It gets that input happening faster.

Terry Wahls, MD

Now, again, to everyone who is listening, I have written grants and we have written grants using electrical stimulation of muscles, reviewing that latest research and adding electrical stimulation to your exercise program dramatically increases your nerve growth factors. And it is the nerve growth factors that really help rebuild and repair my mood. And you have all heard my remarkable story of how much function I was able to improve. It was diet, it was exercise, it was supplemented and it was electrical stimulation, working with a physical therapist very closely who treated me like an athlete and that led to remarkable gains. What makes the NEUBIE different from other devices? Because we have talked about how you have configured that in a very special way.

Garrett Salpeter 

The biggest difference is that we are using direct current as opposed to alternating current. And alternating current as most devices are used because of this kind of interesting quirk of history here where direct current, the benefits were known in the 60s and 70s, but there was also this big problem which is that direct current would burn the surface of the skin and it was a case of the baby being thrown out with the bathwater, that type of metaphor because direct current. People who are developing this type of technology said, okay, we are going to throw away direct current, we can use alternating current because we can get it into the body without any of that risk of skin burning and it is more comfortable, that sort of thing. And alternating current became everything that was being used for decades from the 80s until now, four or five decades. And the issue with alternating current is that you miss out on some of the benefits of direct current. Alternating current, the signal goes positive, negative, positive, negative, you basically do this, charges do this dance back and forth and there is no net electric field. When you have direct current you create this electric field gradient. Electrically speaking that electric field is like, if you have a hill and you roll a ball down it, it will roll down because of gravity, the same thing If you have a field it will cause charges to move. And that is a really powerful phenomenon that happens there, a really powerful situation because it helps to orient the cells in a way that helps with the healing of bone and muscle and connective tissue for injuries. And also helps with the regeneration of nerves. We are studying right now. This one is with neuropathy patients but I will share it here because it is a very similar mechanism. We are using the NEUBIE on Polyneuropathy patients, they have degenerative changes in the peripheral nerves. We are working on that. These ones have changes in the feet, in the lower legs. 

And we are seeing nerve axon regeneration, seeing remyelination as measured by EMG and nerve conduction velocity testing from using that, from taking advantage of these benefits of direct current. And the control group is using a TENS unit using an alternating current device. We are seeing significantly more growth and regeneration. And this is something that probably by the time this airs data collection will be done perhaps this will be submitted for publication, I do not know where exactly will be, but it should be out by the end of 2023, this study. We are seeing these long-term benefits in the realm of tissue regeneration including, especially for this conversation including nerves. And then. Go ahead.

Terry Wahls, MD

How long does it take when you are doing a session? We have someone who has a significant disability, they find someone who is willing to work with them on their Estim. What is the time course? How long should it take?

Garrett Salpeter 

Each session, oftentimes they are structured like a physical therapy session or maybe it is an hour to an hour and a half. The good news about that is, is that there is there are several interesting commentaries in various journals talking about how the average work done in a typical physical therapy session for stroke patients, for MS patients is not enough to drive these neurologic plastic changes. But with technology like this, we can take that 60 to 90-minute session and make it so much more impactful that now it does become enough to start driving these changes, you cross over that threshold. The sessions can be something like that depending on the setting and the individual’s goals. They may or may not be on the device for an entire session or sometimes when their formal session is over maybe they will do extra work on it. They will set the machine on certain settings and then do an extra 20 or 30 minutes while the therapist goes on and works with somebody else, it can be something like that, typically that sort of block of time. And then if people are doing, I mean, you can make a case for trying to do something every day depending on the person’s circumstances or if they are doing something two or three times a week, we expect to start seeing functional changes. Most people see some changes within the first few weeks and it could be something as minor as, hey, I feel the carpet fibers, or I feel a little bit or a little bit of more sensation in my feet, or I have a little bit more ability to lift my foot where I had these drop foot symptoms, or it could be something, or I feel looser, I feel like I can actually bend down and then and tie my shoe where some of that spasticity and tension is starting to diminish and then over time those compound to, hey, I feel like I can actually take some steps now and get out of a wheelchair like, see that takes time. I do not want to diminish the work that goes into that. But we do have dozens of transformation stories like that where people have literally gotten out of wheelchairs and returned to activities of daily living, and regained their autonomy or gotten their driver’s license back, and things like that, but that can take months or one or two or three years to really make those types of changes. There is short-term progress. And then if you stick with it there should be some long-term progress as well as other progress over days and then weeks and then months but it varies for everybody. You do not necessarily know how quickly people are going to respond until you start and try it.

Terry Wahls, MD

And now everyone who is listening, I started doing E-stim for the first time in 2007 when I could barely set up for 10 minutes, that was all I could do and now I can hike, I can bike, can even jog on my treadmill 20 minutes, slowly but I am jogging. I still like doing E-stim. I love doing E-stim And I will still do an hour or two a day because of the cognitive benefits, in addition. My goal is to live until 120. And I want to maintain my muscle mass and be strong to 120. How would someone access the NEUBIE?

Garrett Salpeter 

There are a few ways to do that. Actually, if I may just close the loop on one other element of direct current as well. We talk about these kinds of long-term functional benefits. There also are these short-term functional benefits because it was alternating current as that signal goes back and forth you end up, well, even more generally than that. A lot of times electrical stimulation is about causing muscles to contract. And there is a benefit to that, especially if you can not do it on your own. But this is in some settings we would want even with our device, with the NEUBIE for neuro bioelectric stimulator, even with that we sometimes cause muscles that contract, but a lot of times we are changing the settings to where we can operate with this level of precision to bypass a lot of contraction and more specifically talk to the nerves and nervous system more powerfully, more precisely, send those signals, that helps to create these changes. And the direct current allows us to have that more precise signaling, kind of like running a software debugging program or more precisely programming the software of the nervous system, there is that component. And then to your question about how people can experience this. There are a few different ways. And we certainly, invite people if this is at all intriguing to you and you are patient. There are a growing number of physical therapists, chiropractors, and other professionals that are using this device, certainly here in the United States and then also in other countries, too. I invite you to go to our website which is www.nudeoutfit, just like this light behind me neu but with a dot in the middle NEUBIE, go there. And then you can click on the patients for patients link and there is a map there where you can look up the network of providers. 

We certainly invite you to work with somebody. If there is not anyone in your area or it is difficult to drive around or find a ride or something like that, we have opportunities, we have a team. A physical therapist that can oversee your program if you are interested in getting a device at home. And then we also, with the support of Dr. Wahls here, I have started offering these MS boot camps at our clinics. We are in Austin, Texas. And for MS patients or other patients of other autoimmune degenerative conditions, we have these mass boot camps where you can come and spend three days with us here in Austin and you get to one on one treatments every day and then we do a group lunch and learn or a group activity and of course, we have Wahls protocol, compliant meals. 

And it is great because 95% of people actually notice some improvement even in that first weekend. And then many of them are motivated to either continue with their local therapist when they go back or some of them will take a device home and continue with the custom program, things like that. And then if there are any clinicians listening, we certainly have training and a whole certification program to teach these methods and provide the equipment and things like that. Also on our website, there is a provider’s link that has more information there.

Terry Wahls, MD

Again. The people who would be probably most interested are physical therapists, I suppose, occupational therapists, and chiropractors. How about athletic trainers? I do not know. Do athletic trainers use this device as well?

Garrett Salpeter 

They do. Yeah. We have got 20, at the time of this conversation about 25 professional sports teams across Major League Baseball, NFL, all the different leagues using this, the dozen-plus universities, division one athletic departments using it. Yeah, athletic training is a big application there because their athletes can get back on the field faster and certainly recover faster. And then also, they use it for movement prep and muscle activation before practices and games. And we have a vagus nerve stimulation protocol to help with recovery and heart rate variability and resilience and managing the stresses of a season and all that stuff.

Terry Wahls, MD

Everyone, I love my NEUBIE. I do NEUBIE for one to two hours every day. And I do the vagal program in the evening before bed. Certainly has been very helpful for my sleep as well. Garrett, this has been truly wonderful. I could talk to you all day, of course. But if you are going to have people do just get one nugget from this conversation, what would that be?

Garrett Salpeter 

I think it would be that mindset shift that we talked about a little bit where if. Many of the patients that we talk with that have MS or other neurodegenerative conditions do not think of themselves as athletes, but I would highly encourage you to create that shift and think of yourself as an athlete because what is an athlete? Do an athlete trains hard and gets their training not just once but day after day, week after week, month after month, year after year? And an athlete also supports it. Because if you train hard, if you do your work but then you go stay out till two in the morning because you are drinking at the bar or whatever, that undoes the benefit of training. It is not just the work that you are doing but it is the lifestyle support, it is following the Wahls protocol, it is your sleep habits, it is taking care of everything so that you are supporting so that you maximize not only your ability to do that work but to recover from that and adapt from that. Because the magic happens during recovery, and the rest of the other 22 to 23 hours of the day, thinking like an athlete in your preparation, your training, and your recovery.

Terry Wahls, MD

Okay. Then finally, how do they find you on the web?

Garrett Salpeter 

The best place is www.neu.fit. NEU for neurological. neu.fit

Terry Wahls, MD

And is that dot com or dot org?

Garrett Salpeter 

Just neu.fit. Yeah.

Terry Wahls, MD

Perfect. Okay. This has been wonderful. Thank you so much. I can not wait till I see you again.

Garrett Salpeter 

Thank you, Dr. Wahls.